Pitfalls of fluorodeoxyglucose positron-emission tomography-CT in tuberculosis mimicking malignancy in 60 patients
10.3760/cma.j.issn.1005-1201.2013.01.009
- VernacularTitle:60例活动性结核正电子发射体层摄影-CT误诊为恶性肿瘤的分析
- Author:
Xinlu WANG
;
Jilin YIN
;
Jinhe ZHANG
;
Xi OUYANG
;
Zheng ZHOU
;
Jiangtao QUAN
;
Weibiao ZHANG
;
Hui ZHENG
- Publication Type:Journal Article
- Keywords:
Tuberculosis,pulmonary;
Lung neoplasms;
Lymphoma;
Positron-emission tomography;
Tomography,X-ray computer
- From:
Chinese Journal of Radiology
2013;(1):34-38
- CountryChina
- Language:Chinese
-
Abstract:
Objective To analyze the pitfalls of 18F fluorodeoxyglucose (FDG) positron emission tomography/computer tomography (PET-CT) scan in the diagnosis of 60 patients of tuberculosis mimicking malignancy.Methods The study included 60 patients with PET-CT diagnosis of probable malignancy.Fifty patients were proved to be tuberculosis by pathological examinations and 10 were diagnosed by clinical followup.The images of whole body were acquired at 60 min after administration of 222-555 MBq 18F-FDG.The PET-CT imaging characteristics and clinical data,including lesion size,distribution,standardized uptake value (SUV) were retrospectively analyzed.After the whole body scan of PET-CT,each patient had a chest spiral CT scan for detailed observation of lung lesions.Contrast enhanced CT (CECT) was performed in 8 patients.Results (1)Thirty patients were misdiagnosed as lung cancer,14 patients as malignant lymphoma,6 patients as malignant mesothelioma,3 as intestine carcinoma,2 as bone malignancy,1 patient as hepatocarcinoma,spleen malignancy,ovarian cancer,laryngocarcinoma and nasopharyngeal carcinoma respectively.(2) 90.9％ (20/22) of patients showed normal level of serum CEA and 100％ (13/13) of patients showed normal level of CA199.Increasing serum CA125 was found in all patients (6/6) with activeTB patients accompanied with ascites,pleural fluid and (or) pericardial effusion.(3) 93.3％ (28/30)active tuberculosis showed accumulated 18F-FDG which was incorrectly interpreted as malignancy.The most common sites of TB lymphadenopathy were bilateral cervical tissues,which was accounted for 85.7％(12/14).CECT revealed characteristics of peripheral enhancement and central necrosis in tubercular lymphadenopathy,which was 87.5％ (7/8).Conclusions The diverse manifestations of TB on imaging and high uptake of 18F-FDG on PET imaging result in misdiagnosis of malignancy.It is important for radiologists and nuclear medicine physicians to identify the common imaging features and patterns of TB to make a correct diagnosis.Integration of reconstruction HR CT,PET-CT and lab examinations may improve the diagnostic accuracy.
